A case of intractable infectious keratitis and subsequent flap necrosis after laser in situ keratomileusis

We report on a patient in whom intractable infectious keratitis and subsequent lamellar flap necrosis necessitating flap amputation after laser in situ keratomileusis (LASIK). A 34-year-old woman undergoing LASIK complained of blurred vision and pain in the left eye. The best spectacle-corrected visual acuity was 0.01, and slit-lamp examination showed a marked presence of stromal infiltrates involving the flap and the underlying stroma in that eye. The patient was treated topically with hourly instillation of micronomicin, levofloxacin, and cefmenoxime, together with systemic administration of imipenem, but the left eye developed corneal flap necrosis. We performed surgical debridement of the diseased stroma and excised the lamellar flap. Since nontuberculous mycobacterium was detected on the surgical instruments, we then added oral clarithromycin, and substituted systemic administration of amikacin with that of imipenem. At one month after the flap removal, the visual acuity gradually improved to 0.7, but the stromal opacity of the central cornea and hyperopic shift of +3.0 diopters remained. LASIK can cause intractable keratitis, resulting in significant visual disturbance that presumably results from insufficient antisepsis of the medical instruments used for this surgery, supporting the importance of strict sterilization of these instruments

Successful toric intraocular lens implantation in a patient with induced cataract and astigmatism after posterior chamber toric phakic intraocular lens implantation: a case report

<p>Abstract</p> <p>Introduction</p> <p>We report the case of a patient in whom simultaneous toric phakic intraocular lens removal and phacoemulsification with toric intraocular lens implantation were beneficial for reducing pre-existing astigmatism and acquiring good visual outcomes in eyes with implantable collamer lens-induced cataract and astigmatism.</p> <p>Case presentation</p> <p>A 53-year-old woman had undergone toric implantable collamer lens implantation three years earlier. After informed consent was obtained, we performed simultaneous toric implantable collamer lens removal and phacoemulsification with toric intraocular lens implantation. Preoperatively, the manifest refraction was 0, -0.5 × 15, with an uncorrected visual acuity of 0.7 and a best spectacle-corrected visual acuity of 0.8. Postoperatively, the manifest refraction was improved to 0, -0.5 × 180, with an uncorrected visual acuity of 1.2 and a best spectacle-corrected visual acuity of 1.5. No vision-threatening complications were observed.</p> <p>Conclusion</p> <p>Toric intraocular lens implantation may be a good surgical option for the correction of spherical and cylindrical errors in eyes with implantable collamer lens-induced cataract and astigmatism.</p

Factors influencing subjective symptoms in dry eye disease

AIM: To retrospectively investigate the association between dry eye symptoms and clinical or in vivo confocal microscopy parameters in patients with dry eye disease (DED), and to compare these parameters between eyes with DED and normal subjects. METHODS: This retrospective, cross-sectional, controlled study comprised 25 consecutive patients with non-Sjögren dry eye disease and age- and sex-matched 25 healthy subjects. Each patient underwent a complete examination of the ocular surface in the following order: tear osmolarity measurements, InflammaDry test, tear break-up time, corneal fluorescein staining, Schirmer I test, subjective symptoms questionnaire using the dry eye-related quality-of-life score (DEQS), and in vivo confocal microscopy analysis of the central cornea. Beck depression inventory (BDI) as depressive scale and history of medications and smoking were also evaluated. Stepwise multiple regression analysis was used to assess the factors affecting the DEQS. RESULTS: In univariate analysis, DEQS was associated with tear break-up time (ρ=-0.48, P=0.01), oral medications, such as hypotensive drug (ρ=0.56, P=0.004) and anti-depressant (ρ=0.57, P=0.003), and BDI (ρ=0.61, P=0.001) in patients with DED. In multiple regression analysis, explanatory variables relevant to the DEQS were the anti-depressant medications (P=0.04, partial regression coefficient B=21.04) and BDI (P=0.02, B=0.76, adjusted R2=0.54) in these patients. CONCLUSION: Our study shows a significant association between depression and dry eye symptoms. It suggests that dry eye symptoms associate with higher depressive symptoms and its medications, although our patients were not followed longitudinally

Pengaruh Pemberian Momentum Pada Artificial Neural Network Backpropagation

Salah satu algoritma Artificial Neural Network (ANN) yang biasa digunakan adalah algoritmabackpropagation dengan pola model gradient descent pada proses pembelajarannya. Akan tetapi,gradient descent memiliki kelemahan yaitu tidak mudah digunakan dan terkadang lambat dalampengkonvergenan solusinya. Untuk mengatasi kelemahan tersebut dilakukan suatu modifikasi yaitudengan memberikan momentum pada Perubahan bobotnya. Pada proses prediksi surface roughnesspada CNC Milling menggunakan ANN Backpropagation dengan momentum pada Perubahan bobotini, nilai rata-rata persentase error yang dihasilkan pada masing-masing nilai momentum yangdiberikan adalah tidak banyak mengalami Perubahan. Namun jika nilai momentum yang diberikanmendekati nilai maksimal momentum yaitu mendekati nilai satu maka akan menyebabkanterjadinya overshoot. Pemberian momentum pada Perubahan bobot menyebabkan Perubahan yangcukup besar yaitu pada waktu prosesnya, semakin besar nilai momentum yang diberikan makasemakin cepat pula waktu proses yang dibutuhkan. Hal ini berarti jika ingin waktu prosesprediksinya menjadi cepat maka gunakan nilai momentum yang besar, namun sebaiknya kurangdari 0.9